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United States Patent |
6,245,028
|
Furst
,   et al.
|
June 12, 2001
|
Needle biopsy system
Abstract
A needle biopsy system (10) includes a biopsy needle (210), and a needle
support assembly (200). The needle support assembly (200) holds the biopsy
needle (210) and manipulates the biopsy needle (210) in response to
received control signals. A needle simulator (250) having an input device
(252) generates the control signals in response to manipulation of the
input device (252) by an operator. The operator, in turn, receives
feedback from the needle simulator (250) in accordance with forces
experienced by the biopsy needle (210). In a preferred embodiment, the
feedback received by the operator includes tactile sensations experienced
by the operator as the operator manipulates the input device (252). The
tactile sensations mimic those the operator would have received had the
operator directly manipulated the biopsy needle (210). Optionally, a
curved needle guide (280) is employed to restrict the biopsy needle's
progression longitudinally therethrough.
Inventors:
|
Furst; Daniel S. (Concord, OH);
Chandra; Shalabh (Mayfield Heights, OH);
Heuscher; Dominic J. (Aurora, OH);
Shekhar; Raj (Mayfield Heights, OH)
|
Assignee:
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Marconi Medical Systems, Inc. (Highland Heights, OH)
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Appl. No.:
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449322 |
Filed:
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November 24, 1999 |
Current U.S. Class: |
600/568; 600/411 |
Intern'l Class: |
A61B 010/00 |
Field of Search: |
600/411,416,417,562,564,568
606/130
414/1,5
434/262
|
References Cited
U.S. Patent Documents
5762458 | Jun., 1998 | Wang et al. | 414/1.
|
5876325 | Mar., 1999 | Mizuno et al. | 600/102.
|
5882206 | Mar., 1999 | Gillio | 434/262.
|
6001108 | Dec., 1999 | Wang et al. | 606/130.
|
6074213 | Jun., 2000 | Hon | 434/262.
|
6094590 | Jul., 2000 | Kan et al. | 600/411.
|
6102850 | Aug., 2000 | Wang et al. | 600/102.
|
6113395 | Sep., 2000 | Hon | 434/262.
|
Primary Examiner: Winakur; Eric F.
Assistant Examiner: Marmor, II; Charles
Attorney, Agent or Firm: Fay, Sharpe, Fagan, Minnich & McKee, LLP
Claims
Having thus described the preferred embodiments, the invention is now
claimed to be:
1. A needle biopsy system comprising:
a biopsy needle;
a needle support assembly that holds the biopsy needle and manipulates the
biopsy needle in response to received control signals;
a force measuring transducer associated with the needle support assembly
for measuring forces experienced by the biopsy needle; and,
a needle simulator having an input device, said needle simulator generating
the control signals in response to manipulation of the input device by an
operator, said operator receiving feedback from the transducer in
accordance with the forces experienced by the biopsy needle.
2. The needle biopsy system according to claim 1, wherein the feedback
received by the operator comprises tactile sensations experienced by the
operator as the operator manipulates the input device, said tactile
sensations mimicking those the operator would have received had the
operator directly manipulated the biopsy needle.
3. The needle biopsy system according to claim 1, wherein the force
measuring transducer includes:
a load cell connected to the biopsy needle, said load cell generating force
signals in response to detected forces acting on the biopsy needle, said
force signals being relayed to the needle simulator.
4. The needle biopsy system according to claim 3, wherein the load cell
also generates moment signals in response to moments acting on the biopsy
needle, said moment signals being relayed to the needle simulator.
5. The needle biopsy system according to claim 1, wherein prior to the
needle support assembly manipulating the biopsy needle, the control
signals are filtered to compensate for unwanted manipulations of the input
device by the operator.
6. The needle biopsy system according to claim 1, wherein said needle
biopsy system further includes:
an image guidance system comprising a medical diagnostic imager having a
human viewable display which is employed to visualize procedures.
7. The needle biopsy system according to claim 1, wherein needle biopsy
system further comprises:
an indicator panel having at least one of a visual and an audible signal
controlled in response to the forces experienced by the biopsy needle and
perceivable by the operator.
8. A needle biopsy system comprising:
a biopsy needle;
a needle support assembly that holds the biopsy needle and manipulates the
biopsy needle in response to received control signals;
a needle guide attached to the needle support assembly, said needle guide
comprising a hollow shaft dimensioned to receive the biopsy needle such
that the biopsy needle freely progresses longitudinally therethrough while
restricting the needle's lateral movement; and
a needle simulator having an input device, said needle simulator generating
the control signals in response to manipulation of the input device by an
operator, said operator receiving feedback from the transducer in
accordance with the forces experienced by the biopsy needle.
9. The needle biopsy system according to claim 8, wherein the hollow shaft
is curved.
10. The needle biopsy system according to claim 8, wherein the biopsy
needle is connected to the needle support assembly via a quick release
coupling arranged such that the biopsy needle is readily detachable from
the needle support assembly.
11. The needle biopsy system according to claim 10, wherein the quick
release coupling automatically releases the biopsy needle from the needle
support assembly upon application of an amount of force thereto in excess
of a determined level.
12. A method for performing a needle biopsy on a subject, said method
comprising:
(a) adjusting a needle support assembly which holds a biopsy needle such
that the biopsy needle is positioned relative to the subject at a desired
insertion point and orientation;
(b) manipulating an input of a needle simulator remote from said needle
support assembly in order to effect a desired manipulation of the biopsy
needle;
(c) generating a needle control signal in response to the manipulation of
the input of the needle simulator;
(d) relaying the needle control signal to the needle support assembly;
(e) producing the desired manipulation of the biopsy needle in response to
the needle control signal;
(f) sensing a force on the biopsy needle;
(g) generating a force signal in response to the sensed force on the biopsy
needle;
(h) relaying the force signal to the needle simulator; and,
(i) applying tactile feedback to the input of the needle simulator in
response to the force signal.
13. The method according to claim 12, wherein the tactile feedback mimics
tactile sensations which would have been felt had the biopsy needle been
manipulated directly.
14. The method according to claim 12, wherein between steps (c) and (e) the
method further comprises:
filtering the control signal to compensate for unwanted components of the
manipulation of the input of the needle simulator.
15. The method according to claim 12, wherein during the needle biopsy said
method further comprises:
obtaining medical diagnostic images of a region of interest of the subject,
said region of interest having the biopsy needle located therein.
16. The method according to claim 12, wherein the method further comprises:
providing a human perceivable signal in response to the force signal.
17. The method according to claim 16, wherein the human perceivable signal
is an alarm which is triggered when the force signal crosses a determined
threshold.
18. An image-guided needle biopsy system, said system comprising:
a CCT imaging unit having a subject support for suspending a subject at
least partially within an examination region;
a biopsy needle; and
a mechanical needle biopsy system, said mechanical needle biopsy system
comprising:
a robotic arm adjustably mounted to said subject support, said robotic arm
inserting and retracting the biopsy needle into and out of the subject and
sensing forces acting on the biopsy needle;
a needle guide through which the biopsy needle is directed, said needle
guide being detachably mounted to the robotic arm; and,
a haptic needle simulator that is manipulated in order to control the
biopsy needle remotely, said haptic needle simulator reflecting sensed
forces acting on the biopsy needle to an interventionalist manipulating
the haptic needle simulator.
19. The image-guided needle biopsy system according to claim 18, wherein
the biopsy needle is flexible and the needle guide is curved.
20. The image-guided needle biopsy system according to claim 18, wherein
the biopsy needle is detachably coupled to the robotic arm.
Description
BACKGROUND OF THE INVENTION
The present invention relates to minimally invasive surgical systems and
methods. It finds particular application in conjunction with image-guided
needle biopsies performed using continuous computed tomography (CCT)
scanning or other similar imaging systems, and will be described with
particular reference thereto. However, it is to be appreciated that the
invention is also applicable to other imaging modalities and other biopsy
surgical techniques.
It is often desirable to sample or test a portion of tissue from human or
animal subjects, particularly in the diagnosis and treatment of
potentially cancerous tumors, pre-malignant conditions, and other diseases
or disorders. Typically, in the case of tumors, when the physician
suspects that cancer or an otherwise diseased condition exists, a biopsy
is performed to determine if in fact cells from the tumor are cancerous or
otherwise diseased. Many biopsies, such as percutaneous biopsies, are
performed with a needle-like instrument used to collect the cells for
analysis.
In recent years, the performance of needle biopsies has been enhanced by
the use of x-ray and computed tomography (CT) scans. The imaging equipment
allows an interventionalist, such as a radiologist, surgeon, physician, or
other medical personnel, to track the insertion of interventional devices,
such as biopsy needles, in a subject during diagnostic and therapeutic
procedures. While such imaging modalities are helpful to the
interventionalist and the patient, they have certain drawbacks.
For example, with such image-guided procedures, the tracking of needle
position is not done in real-time. That is to say, a static image is
obtained and the needle position noted therein. Subsequently, the needle
is advanced or retracted by a small amount and another static image
obtained to verify the new needle position. This sequence is repeated as
many times as necessary to track the needle's progression. Such a
procedure tends to be time consuming insomuch as the needle progresses by
only a short distance or increment between imaging, and needle progression
is halted during imaging. Moreover, accuracy suffers to the extent that in
the interim, i.e., between images, the needle's position cannot be
visualized.
With the development of CCT imaging and fluoroscopy, real-time imaging has
been made possible. In CCT scanning, a rotating x-ray source irradiates
the subject continuously, generating images at a rate of approximately six
frames per second. The use of CCT or fluoroscopy by the interventionalist
for real-time guidance and/or tracking of the needle during biopsies is
gaining popularity. As a result, biopsies have become not only more
accurate, but also shorter in duration.
However, a problem resides in protecting the interventionalist from
radiation exposure. In needle biopsies, for example, often the biopsy
needle and guide are held within or close to the plane of the x-ray
radiation so that the needle-tip will reside in the image plane thereby
permitting continuous tracking. Staying close to the plane of imaging
also, more often than not, allows for the distance the needle passes
through the subject to be minimized. Consequently, this typically results
in the interventionalist placing his/her hands in the x-ray beam. The
hands of an interventionalist who performs several such procedures per day
can easily receive a toxic dose of radiation. Therefore, it is desirable
to provide interventionalists with a way to perform needle biopsies using
CCT scanning without the risk of radiation exposure.
One proposed approach involves the use of a mechanical system which allows
the interventionalist to manipulate the biopsy needle while his hands
remain clear of the x-ray beam. However, such systems with mechanical
linkages reduce or eliminate the tactile sensations (e.g., force, shear,
and/or moment on the needle) otherwise available to an interventionalist
directly manipulating the needle. This is disadvantageous in that
interventionalists typically obtain useful information regarding the
procedure from these tactile sensations. For example, they are often able
to feel the needle transition between different tissue types, contact with
bones, etc. The interventionalist generally desire this "feel" as they
perform biopsies. To trained personnel, it serves as an additional
indication of the needle's location.
The present invention provides a new and improved system and technique for
performing a needle biopsy that overcomes the above-referenced problem and
others.
SUMMARY OF THE INVENTION
In accordance with one aspect of the present invention, a needle biopsy
system includes a biopsy needle and a needle support assembly. The needle
support assembly holds the biopsy needle and manipulates the biopsy needle
in response to received control signals. A needle simulator using an input
device generates the control signals in response to manipulation of the
input device by an operator. The operator, in turn, receives feedback from
the needle simulator in accordance with forces experienced by the biopsy
needle.
In accordance with a more limited aspect of the present invention, the
feedback received by the operator includes tactile sensations experienced
by the operator as he manipulates the input device. The tactile sensations
mimic those that the operator would have received had he directly
manipulated the biopsy needle.
In accordance with a more limited aspect of the present invention, the
needle biopsy system further includes a force measuring transducer
associated with the needle support assembly for measuring forces
experienced by the biopsy needle.
In accordance with a more limited aspect of the present invention, the
force measuring transducer includes a load cell connected to the biopsy
needle. The load cell generates force signals in response to detected
forces acting on the biopsy needle. The force signals are then relayed to
the needle simulator.
In accordance with a more limited aspect of the present invention, the load
cell also generates moment signals in response to detected moments acting
on the biopsy needle. The moment signals are then relayed to the needle
simulator.
In accordance with a more limited aspect of the present invention, the
needle biopsy system further includes a needle guide attached to the
needle support assembly. The needle guide is a hollow shaft dimensioned to
receive the biopsy needle such that it freely progresses longitudinally
there through while being restricted in its lateral movement.
In accordance with a more limited aspect of the present invention, the
hollow shaft is curved.
In accordance with a more limited aspect of the present invention, the
biopsy needle is connected to the needle support assembly via a quick
release coupling arranged so that the biopsy needle is readily detachable
from the needle support assembly.
In accordance with a more limited aspect of the present invention, the
quick release coupling automatically releases the biopsy needle from the
needle support assembly upon application of an amount of force thereto in
excess of a determined level.
In accordance with a more limited aspect of the present invention, prior to
the needle support assembly manipulating the biopsy needle, the control
signals are filtered to compensate for unwanted manipulations of the input
device by the operator.
In accordance with a more limited aspect of the present invention, the
needle biopsy system further includes an image guidance system. The image
guidance system is a medical diagnostic imager having a human viewable
display which is employed to visualize procedures.
In accordance with a more limited aspect of the present invention, the
biopsy needle system further includes an indicator panel having at least
one operator perceivable visual and/or audible signal controlled in
response to the forces experienced by the biopsy needle.
In accordance with another aspect of the present invention, a method for
performing a needle biopsy on a subject is provided. The method includes
adjusting a needle support assembly which holds a biopsy needle such that
the biopsy needle is positioned relative to the subject at a desired
insertion point and orientation. Thereafter, an input of a needle
simulator remote from the needle support assembly is manipulated in order
to affect a desired manipulation of the biopsy needle. A needle control
signal is generated in response to the manipulation of the input of the
needle simulator. The needle control signal is then relayed to the needle
support assembly, and the desired manipulation of the biopsy needle is
produced in response to the needle control signal. A force on the biopsy
needle is sensed, and a force signal is generated in response to the
sensed force on the biopsy needle. Next, the force signal is relayed to
the needle simulator, and tactile feedback is applied to the input of the
needle simulator in response to the force signal.
In accordance with a more limited aspect of the present invention, the
tactile feedback mimics tactile sensations which would have been felt by
the medical professional had he been manipulating the biopsy needle
directly.
In accordance with a more limited aspect of the present invention, between
the steps of generating a needle control signal and producing the desired
manipulation, the method further includes filtering the control signal to
compensate for unwanted components of the manipulation of the input of the
needle simulator.
In accordance with a more limited aspect of the present invention, during
the needle biopsy, the method further includes obtaining medical
diagnostic images of a region of interest of the subject. The region of
interest has the biopsy needle located therein.
In accordance with a more limited aspect of the present invention, the
method further includes providing a human perceivable signal in response
to the force signal.
In accordance with a more limited aspect of the present invention, the
human perceivable signal is an alarm which is triggered when the force
signal crosses a determined threshold.
In accordance with another aspect of the present invention, an image-guided
needle biopsy system includes a CCT imaging unit having a subject support
for suspending a subject at least partially within an examination region.
It also includes a biopsy needle and a mechanical needle biopsy system.
The mechanical needle biopsy system includes a robotic arm adjustably
mounted to the subject support. The robotic arm inserts and retracts the
biopsy needle into and out of the subject and senses forces acting on the
biopsy needle. A needle guide directs the biopsy needle there through. The
needle guide is detachably mounted to the robotic arm. An included haptic
needle simulator is manipulated in order to control the biopsy needle
remotely. The haptic needle simulator reflects sensed forces acting on the
biopsy needle to an interventionalist manipulating the haptic needle
simulator.
In accordance with a more limited aspect of the present invention, the
biopsy needle is flexible and the needle guide is curved.
In accordance with a more limited aspect of the present invention, the
biopsy needle is detachably coupled to the robotic arm.
One advantage of the present invention is that it provides a safe
environment for interventionalists to perform needle biopsies with
real-time image guidance.
Another advantage of the present invention is that interventionalists have
available information from the tactile sensations associated with the
needle biopsy.
Yet another advantage of the present invention is that it provides a more
sterile environment for needle biopsies.
Still another advantage of the present invention is that it provides a more
convenient and comfortable environment for the interventionalist when
performing a biopsy or other like procedure, i.e., rather than awkwardly
leaning over the patient.
Yet another advantage of the present invention is that it provides for
"tele-biopsy" procedures from remote locations.
Still further advantages and benefits of the present invention will become
apparent to those of ordinary skill in the art upon reading and
understanding the following detailed description of the preferred
embodiments.
BRIEF DESCRIPTION OF THE DRAWINGS
The invention may take form in various components and arrangements of
components, and in various steps and arrangements of steps. The drawings
are only for purposes of illustrating preferred embodiments and are not to
be construed as limiting the invention.
FIG. 1 is a diagrammatic illustration of an image-guided needle biopsy
system in accordance with aspects of the present invention;
FIG. 2 is a diagrammatic illustration of a needle support assembly in
accordance with aspects of the present invention;
FIG. 3 is a diagrammatic illustration of a needle support arm with needle
guide in accordance with aspects of the present invention; and
FIG. 4 is a diagrammatic illustration of a haptic needle simulator and
indicator panel in accordance with aspects of the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
With reference to FIG. 1, an image-guided needle biopsy system 10 includes
a diagnostic imaging apparatus 100 capable of generating continuous
medical diagnostic images of a subject 20 updated in real-time or at close
temporal intervals, six images per second in a preferred embodiment.
In a preferred embodiment, the diagnostic imaging apparatus 100 includes a
CT scanner having a stationary gantry 110 which defines a central
examination region 112. A rotating gantry 114 is mounted on the stationary
gantry 110 for rotation about the examination region 112. A source of
penetrating radiation 120, such as an x-ray tube, is arranged on the
rotating gantry 114 for rotation therewith. The source of penetrating
radiation produces a beam of radiation 122 that passes through the
examination region 112 as the rotating gantry 114 rotates. A collimator
and shutter assembly 124 forms the beam of radiation 122 into a thin
fan-shape and selectively gates the beam 122 on and off. Alternately, the
radiation beam 122 is gated on and off electronically at the source 120.
Nevertheless, the source 120 remains on for the duration of a continuous
imaging scan. Using an appropriate reconstruction algorithm in conjunction
with the data acquired from the CT scanner, images are continuously
reconstructed and updated at 6 frames a second. This mode of operation of
the scanner is called the CCT mode.
A subject support 130, such as an operating table, couch or the like,
suspends or otherwise holds the subject 20 received thereon, such as a
human or animal patient, at least partially within the examination region
112 such that the thin fan-shaped beam of radiation 122 cuts a
cross-sectional slice through the region of interest of the subject 20.
In the illustrated fourth generation CT scanner, a ring of radiation
detectors 140 is mounted peripherally around the examination region 112 on
the stationary gantry 110. Alternately, a third generation CT scanner is
employed with an arc of radiation detectors 140 mounted on the rotating
gantry 114 on a side of the examination region 112 opposite the source 120
such that they span the arc defined by the thin fan-shaped beam of
radiation 122. Regardless of the configuration, the radiation detectors
140 are arranged to receive the radiation emitted from the source 120
after it has traversed the examination region 112.
In a source fan geometry, an arc of detectors which span the radiation
emanating from the source 120 are sampled concurrently at short time
intervals as the source 120 rotates behind the examination region 112 to
generate a source fan view. In a detector fan geometry, each detector is
sampled a multiplicity of times as the source 120 rotates behind the
examination region 112 to generate a detector fan view. The paths between
the source 120 and each of the radiation detectors 140 are denoted as
rays.
The radiation detectors 140 convert the detected radiation into electronic
projection data. That is to say, each of the radiation detectors 140
produces an output signal which is proportional to an intensity of
received radiation. Optionally, a reference detector may detect radiation
which has not traversed the examination region 112. A difference between
the magnitude of radiation received by the reference detector and each
radiation detector 140 provides an indication of the amount of radiation
attenuation along a corresponding ray of a sampled fan of radiation. In
either case, each radiation detector 140 generates data elements which
correspond to projections along each ray within the view. Each element of
data in the data line is related to a line integral taken along its
corresponding ray passing through the subject being reconstructed.
The image data from the radiation detectors 140 is collected and
reconstructed into an image representation of the subject 20 in the usual
manner. For example, a data processing unit 150 collects the image data
and reconstructs the image representation therefrom using rebinning
techniques, convolution/backprojection algorithms, and/or other
appropriate reconstruction techniques. In a preferred embodiment, the
image representation, corresponding to the cross-sectional slice traversed
by the thin fan-shaped beam of radiation 122 through the region of
interest of the subject 20, is displayed on a human viewable display, such
as a video monitor 160 or the like. Preferably, during operation in the
CCT scan mode, the image representation is updated at a rate of
approximately 6 frames per second or more. In this manner then, an
interventionalist performing a biopsy is able to track needle progression
in real-time by viewing the image representation displayed on the video
monitor 160.
With reference to FIG. 2 and continuing reference to FIG. 1, in a preferred
embodiment, the image-guide needle biopsy system 10 also includes a
mechanical needle support assembly 200 which holds a biopsy needle 210 at
a desired location and trajectory. The mechanical needle support assembly
200 optionally includes an arch support assembly 220 and a needle support
arm 230. The arch support assembly 220 preferably comprises substantially
rigid members extending in an arch from one side of the subject support
130 to the other leaving clearance for the subject 20 thereunder.
Optionally, the arch support assembly 220 is height adjustable. In a
preferred embodiment, the arch support assembly 220 is attached to the
subject support 130 on either side via longitudinally extending guides,
tracks, or the like, along which the arch support assembly 220 is
selectively positioned and/or fixed as desired. Likewise, the arch support
assembly 220 serves as a laterally extending guide or track along which a
first end of the needle support arm 230 is selectively positioned and/or
fixed as desired.
The needle support arm 230 is preferably a fully adjustable multi-jointed
multi-segmented arm with each joint having varying degrees of freedom
(optionally, universal or ball type joints) and each segment being
selectively expandable and retractable. As will be described in greater
detail later herein, the biopsy needle 210 is held and/or otherwise
attached to an end opposite the first end of the needle support arm 230.
Accordingly, by appropriately selecting the longitudinal position of the
arch support assembly 220 along the subject support 130, and appropriately
selecting the lateral position of the needle support arm 230 along the
arch support assembly 220, and flexing or otherwise adjusting the multiple
joints and/or segments of the needle support arm 230, any arbitrary
position and/or orientation of the biopsy needle 210 relative to the
subject 20 is achieved as desired.
With reference to FIG. 3 and continuing reference to FIGS. 1 and 2,
performance of the biopsy preferably begins with adjusting the mechanical
needle support system 200 so that the biopsy needle 210 is initially set
at the desired insertion location and oriented along the desired
trajectory. So that the biopsy needle's location is visualized throughout
its entire progression, and to minimize the distance the biopsy needle 210
travels through the subject 20, the trajectory preferably resides in the
plane of the beam of radiation 122. The biopsy needle 210 is initially set
by sliding or otherwise positioning the needle support arm 230 laterally
along the arch support assembly 220 and sliding or otherwise positioning
the arch support assembly 220 longitudinally along the subject support
130. The arch support assembly 220 and the needle support arm 230 together
provide complete freedom for the positioning and orienting of the biopsy
needle 210. After initial positioning and during the needle biopsy
procedure, the CT scanner is employed in the CCT mode to image the region
of interest (i.e. the plane of the thin fan-shaped beam of radiation 122)
with the biopsy needle 210 therein.
Optionally, in an alternative embodiment, the biopsy needle 210 is
automatically positioned. That is to say, the medical professional or
other operator maps out the procedure by identifying the location of a
tumor in a prior obtained image and a desired angle of needle insertion.
In response, the mechanical needle support system 200 automatically (via
mechanical drivers and relative position sensors) locates the biopsy
needle 210 at the appropriate position for performing the mapped
procedure.
Optionally, adjustable biopsy tables 240 may be attached to the subject
support 130 for convenience during the procedure. These tables 240, which
are outside of the beam of radiation 122, are used to support or otherwise
hold and make readily available additional components (as discussed
elsewhere herein) of the image-guided needle biopsy system 10, surgical
and interventional tools, and/or other instruments used by the
interventionalist during the procedure. Additionally, the biopsy tables
240 are optionally swung into position over the subject 20 so that the
interventionalist can support and/or steady his hand or body therefrom in
cases where it is desired to manually perform the biopsy, either partially
or in its entirety.
With reference to FIG. 4 and continuing reference to FIGS. 1 through 3, in
a preferred embodiment, the image-guided needle biopsy system 10 further
includes a remote haptic needle simulator 250 which has a joystick 252 or
other asuch input device that is physically manipulated by the
interventionalist to, in turn, manipulate and/or control the actual biopsy
needle 210. Preferably, the needle support arm 230 is a robotic arm whose
multiple joints flex or otherwise rotate and segments expand or retract in
accordance with control signals received from the haptic needle simulator
250. The control signals generated by the haptic needle simulator 250 are
such that the action of the needle support arm 230 mimics, either directly
or by a scaled amount, the interventionalist's physical manipulation of
the joystick 252. These control signals are relayed from the remotely
located haptic needle simulator 250 to the needle support arm 230
optionally via physical cable or in a wireless fashion using an infrared
link, radio communication, or the like. In this manner then, the remote
nature of the haptic needle simulator 250 allows it to be arbitrarily
positioned. Accordingly, to the degree desired, the interventionalist is
kept clear of the radiation.
Prior to being relayed to the needle support arm 230, the control signals
are optionally filtered by a steady-hand filter 254. Alternately, the
steady-hand filter 254 operates on the receiving end and is incorporated
with the needle support arm 230. In either case, the steady-hand filter
254 removes, smooths out, or otherwise filters, from the control signals,
noise or signal components which are a result of an interventionalist's
hand tremors. Consequently, slightly unstable and/or unwanted
displacements of the biopsy needle 210 do not result from these hand
tremors. Filtering out hand tremor noise provides for a more stable and
accurate needle biopsy. Additionally, the steady-hand filter 254 prevents
sudden, sharp movement of the biopsy needle 210. This feature is important
in the case of a slip or flinch by the interventionalist. Such a sharp and
unintentional movement is potentially harmful to the subject 20. That is
to say, the steady-hand filter 254 "catches" such an unintentional hand
movement and blocks the control signal from causing a resultant
displacement of the biopsy needle 210. Optionally, other signal or data
processing as appropriate is also performed prior to the needle support
arm 230 responding to the control signals.
A force and moment measuring assembly 260, preferably comprising a load
cell which contains pressure and moment transducers, or other such
force/moment measuring devices, which record or otherwise measure the
forces and/or moments experienced by the biopsy needle 210 as it is
manipulated. Preferably, the force measuring assembly 260 is held by,
attached to, or otherwise incorporated with the end of the needle support
arm 230. The biopsy needle 210 is, in turn, connected to a force/moment
sensing input 262 of the measuring assembly 260. The force/moment
measuring assembly 260 generates force and moment signals in response to
the forces and moments sensed by the force/moment sensing input 262 which
result from the forces and moments experienced by the connected biopsy
needle 210. In its preferred embodiment, the force and moment measuring
assembly 260 comprises a single load cell which generates a corresponding
signal in response to all the forces and moments (i.e., in and/or about
three orthogonal directions) experienced by the biopsy needle 210 which is
connected to the load cell's input 262. This allows for the measuring of
shear and transverse forces along with the axial force experienced by the
biopsy needle 210. However, in alternate embodiments, optionally, the
biopsy needle 210 is mechanically linked to one or more load cells which
each measures a single shear, transverse, or axial force or moment. In any
event, it is preferred that the biopsy needle 210 be attached to the force
and moment measuring assembly 260 via a quick release connection or
coupling 270 so that, if the interventionalist desires to proceed
manually, the biopsy needle 210 is readily freed from the mechanical
needle support assembly 200.
It is also preferred, that the needle support arm 230 and/or associated
detectors generate position signals indicative of its movement. For
example, a detector incorporated in each of the multiple joints and/or
segments optionally senses an amount of rotation for that joint or amount
of expansion/retraction for that segment. From a starting position,
determining the amount of rotation in each joint and expansion/retraction
in each segment then determines the location and orientation of the needle
support arm 230 in relation to that starting position. Consequently, the
movement of the needle support arm 230 and connected biopsy needle 210 is
readily determined.
Additionally, in an alternate embodiment, the force and moment measuring
assembly 260 is omitted and the biopsy needle 210 attached, again via the
quick release connection or coupling 270, to the end of the needle support
arm 230. In this embodiment then, detectors associated with the joints and
segments of the needle support arm 230 also sense resistance to their
movements and generate signals responsive thereto. From these signals, the
forces experienced by the biopsy needle 210 are calculated or otherwise
determined to generate the force signals.
Ultimately, the generated force and moment signals and position signals are
relayed back to the haptic needle simulator 250 also via physical cable or
in a wireless fashion using an infrared link, radio communication, or the
like. In response to the received feedback (i.e., force and moment signals
and position signals), the haptic needle simulator 250 reflects or mimics
the forces and motion experienced by the biopsy needle 210 in the joystick
252 by applying appropriate forces, moments, and/or resistance thereto. In
this manner then, via the joystick 252, the interventionalist who is
physically manipulating the joystick 252 receives the same tactile
sensations and/or feels the forces and moments experienced by the biopsy
needle 210 as if he were directly manipulating the biopsy needle 210.
Moreover, the flexibility in location of the haptic needle simulator 250
makes it possible for an expert at a remote location, optionally even a
distant hospital, to perform the procedure with the same tactile feedback
as if he were manually handling the biopsy needle 210.
In one preferred embodiment, a needle guide 280 is attached to the
mechanical needle support assembly 200. The needle guide 280 is a
substantially rigid hollow tube or shaft having an inner diameter and/or
other inside dimensions sized to receive the biopsy needle 210. The
illustrated needle guide 280 is curved. However, in an alternate
embodiment, it is straight. In the case of the curved needle guide 280,
the biopsy needle 210 used therewith is flexible in order to navigate the
bend, and the bend is gradual in order to reduce friction between the
biopsy needle 210 and inside walls of the needle guide 280 as the biopsy
needle 210 progresses through the needle guide 280. In either case, curved
or straight, it is preferred that the needle guide 280 or at least its
inside walls are made from a low coefficient of friction material
consistent with medical use. Moreover, the fit of the biopsy needle 210
within in the needle guide 280 is such that the biopsy needle 210 is
freely advanced and/or retracted longitudinally therethrough, but without
significant lateral play. In this manner then, the biopsy needle 210 has
minimal frictional forces acting thereon, so that the forces experienced
by the manipulator of the biopsy needle 210, either via the needle
simulator 250 or via direct manipulation, is substantially the same as if
no needle guide is involved in the procedure.
The advantage of employing a curved needle guide 280 is twofold. In the
first instance, the curved needle guide 280 allows the mechanics (i.e.,
the needle support assembly 200, etc.) of the image-guided needle biopsy
system 10 to be displaced from the site of needle insertion and image
plane. Consequently, the mechanics of the system do not interfere with
imaging. In the second instance, a curved needle guide 280 keeps the
interventionalist's hands out of the beam of radiation 122 in situations
where the interventionalist desires to attend to the procedure manually.
This is an important feature in light of the fact that radiation exposure
is a serious risk for interventionalists who regularly perform such
procedures.
Placement of the needle guide 280 determines the insertion location and
ensures the orientation or trajectory of the biopsy needle 210 insomuch as
the biopsy needle 210 is constrained to only be advanced and/or retracted
longitudinally therethrough. The needle guide's attachment to the needle
support assembly 200 allows the needle guide 280 to be arbitrarily placed,
oriented, and/or fixed with respect to the subject 20. In the illustrated
embodiment, the needle guide 280 is attached to the needle support
assembly 200 via an adjustable mechanical linkage 282 connected to a
segment of the needle support arm 230. Alternately, the linkage 282
connects the needle guide 280 directly to the arch support assembly 220.
In addition, the linkage 282 includes a quick release connection or
coupling 284 so that, if desired, the needle guide 280 is readily
disengaged from the needle support assembly 200.
In a preferred embodiment, the image-guided needle biopsy system 10 also
includes an augmented feedback feature as well as a warning feature
incorporated in an indicator panel 300 which also receives the same
signals received by the haptic needle simulator 250. As with the haptic
needle simulator 250, the indicator panel 300 optionally receives the
feedback via physical cable, infrared link, radio communication, or the
like. The indicator panel 300 includes a combination of visual and/or
audible indicators which are triggered or controlled upon the detection of
a predetermined or otherwise defined condition. For example, an audible
indicator (e.g., a speaker, an acoustic transducer, etc.) has its volume
or other acoustic characteristic controlled in response to the amount of
axial force experienced by the biopsy needle 210. This feedback then
augments the tactile feedback received by the interventionalist and gives
the interventionalist an additional indication of the forces exerted on
the biopsy needle 210. In terms of a warning, an audible alarm may sound
to alert the interventionalist if the biopsy needle 210 hits bone.
Optionally, that determination is made when a force signal exceeds an
acceptable threshold. Alternately, the indicators are visual, such as
flashing or steady state light emitting diodes (LEDs) of various patterns
and/or colors. Additionally, the control panel 300 contains an alarm which
is triggered if the system is not calibrated properly or not functioning.
This safety feature prevents potential physical harm to the subject 20 due
to failures in the system.
In addition, in a preferred embodiment, the image-guided needle biopsy
system 10 contains a depth fail-safe feature which prevent over insertion
of the biopsy needle 210. This optionally takes the form of mechanical
stop 400 attached to the biopsy needle 210. The mechanical stop 400 abuts
an end the needle guide 280 when the biopsy needle 210 is inserted to the
desired depth thereby preventing further insertion. This feature is
particularly valuable for procedures near critical areas, such as the
spine or heart. The mechanical stop 400 is set for variable depths
depending on the region of the subject 20 in which the procedure is being
performed. In an alternate embodiment, stops are incorporated in the
joints and segments of the needle support arm 230 to prevent over
extension thereof. In yet another alternate embodiment, electronic
controls limit the amount of insertion.
Another fail-safe feature optionally incorporated in the image-guided
needle biopsy system 10 guards against subject injury caused by an
unwanted shifting of the subject 20. Under these circumstances, the
subject 20 may be injured when the biopsy needle 210 is not free to move
with the subject 20. Accordingly, to reduce this risk, both quick release
connections or couplings 270 and 284 are made to automatically disengage
and/or separate when subjected to a shear force or pressure greater than
an acceptable threshold.
There are many advantages in the present image-guided needle biopsy system
10 over biopsy systems and devices disclosed in the prior art. In the
prior art, if an interventionalist wants to enjoy the benefits of
real-time needle guidance via CCT imaging or fluoroscopy, the
interventionalist typically exposes his hands to a potentially toxic dose
of radiation over the course of several procedures. In contrast, the
current image-guided needle biopsy system 10 allows the interventionalist
to enjoy the advantages of real-time imaging without the risk of radiation
exposure. This is true even where the interventionalist wishes to manually
override the mechanical system and perform the procedure by hand. Use of
the curved needle guide 300 still allows the interventionalist to keep his
hands outside of the beam of radiation 122.
The image-guided needle biopsy system 10 of the present invention also
allows for a more comfortable working environment for the
interventionalist. In performing a needle biopsy manually, an
interventionalist must often lean over the subject 20 in order to access
the desired insertion point and/or orientation. This can be particularly
troublesome in the case of larger subjects. In any event, leaning over the
subject 20 in this manner potentially results in discomfort for the
interventionalist and/or it may tend to cause him to be unsteady. In
contrast, the image-guided needle biopsy system 10 in accordance with
embodiments of the present invention, is easily manipulated by the
interventionalist in a comfortable environment. The interventionalist may
sit at one of the biopsy tables 240 on which rests the needle simulator
250, or he may sit in another room altogether. Either way, his arm is more
readily supported in the proper manner to promote stability and comfort,
and thereby, accuracy is enhanced. It is important to note that this
increased stability and comfort do not come at the price of reduced
tactile sensation or feel. Because of the force-reflecting haptic aspect
of the needle simulator 250, the interventionalist enjoys the same tactile
sensation, feel, and/or feedback as does an interventionalist performing
the procedure manually.
Use of the image-guided needle biopsy system 10 also promotes a more
sterile environment for the biopsy. Having fewer people come in contact
with a subject 20 reduces the risk of infection. Therefore, with proper
sterilization of the biopsy needle 210 and other components in near
proximity to the site, the procedure is readily performed in a very
sterile environment with a low likelihood of contamination.
The invention has been described with reference to the preferred
embodiments. Obviously, modifications and alterations will occur to others
upon reading and understanding the preceding detailed description. It is
intended that the invention be construed as including all such
modifications and alterations insofar as they come within the scope of the
appended claims or equivalents thereof.
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